| NPI | 1508006644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P9696) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NC 9696) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2024-03-20 |